Gut Microbiota and Acute Diverticulitis: Role of Probiotics in Management of This Delicate Pathophysiological Balance

How can the knowledge of probiotics and their mechanisms of action be translated into\r\nclinical practice when treating patients with diverticular disease and acute diverticulitis? Changes in\r\nmicrobiota composition have been observed in patients who were developing acute diverticulitis,\r\nwith a reduction of taxa with anti-inflammatory activity, such as Clostridium cluster IV, Lactobacilli\r\nand Bacteroides. Recent observations supported that a dysbiosis characterised by decreased presence\r\nof anti-inflammatory bacterial species might be linked to mucosal inflammation, and a vicious\r\ncycle results from a mucosal inflammation driving dysbiosis at the same time. An alteration in gut\r\nmicrobiota can lead to an altered activation of nerve fibres, and subsequent neuronal and muscular\r\ndysfunction, thus favoring abdominal symptoms’ development. The possible role of dysbiosis\r\nand mucosal inflammation in leading to dysmotility is linked, in turn, to bacterial translocation\r\nfrom the lumen of the diverticulum to perivisceral area. There, a possible activation of Toll-like\r\nreceptors has been described, with a subsequent inflammatory reaction at the level of the perivisceral\r\ntissues. Being aware that bacterial colonisation of diverticula is involved in the pathogenesis of acute\r\ndiverticulitis, the rationale for the potential role of probiotics in the treatment of this disease becomes\r\nclearer. For this review, articles were identified using the electronic PubMed database through a\r\ncomprehensive search conducted by combining key terms such as “gut microbiota”, “probiotics and\r\ngut disease”, “probiotics and acute diverticulitis”, “probiotics and diverticular disease”, “probiotics\r\nmechanism of action”. However, the amount of data present on this matter is not sufficient to draw\r\nrobust conclusions on the efficacy of probiotics for symptoms’ management in diverticular disease.